Condom and safer sex product availability among U.S. College health centers.

Author:Butler, Scott M.
 
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Introduction

Research and epidemiological data have revealed public health, medical, and economic impacts of sexually transmitted infections (STIs) and unintended pregnancy among adolescents and young adults (CDC, 2009; Chesson, Blanford, Gift, Tao, & Irwin, 2004; Institute of Medicine, 1995). According to the CDC (2009), sexually active 15 - 24 year olds are at higher risk for STIs for a variety of reasons including behavioral, biological, and cultural factors. The use of male latex condoms reduces the risk of human immunodeficiency virus (HIV), gonorrhea, chlamydia infection, and genital human papillomavirus (HPV) infection in women, and is associated with the clearance/regression of HPV and HPV-related illness (Ahmed et al., 2001; Bleeker et al., 2003; Hogewoning et al., 2003; Sanchez et al., 2003; Winer, 2006). With regard to unintended pregnancy, condom efficacy is 98% among users who exhibit "perfect use" over the course of a 1-year time period, and 85% when users exhibit "typical use" (Trussell, 2007).

Researchers at the Center for Sexual Health Promotion at Indiana University recently published findings from the National Survey of Sexual Health and Behavior (NSSHB; Reece et al., 2010a). The NSSHB is a large (n = 5,865), nationally representative cross-sectional survey of sexuality and sexual health behaviors of U.S. residents 14 - 94 years old. With regard to condom use, findings indicated that among participants who had vaginal intercourse within the last year, men 18 - 24 years old used a condom 44.9% (95% CI = 37.4% 52.7%) of the time during their most recent 10 occurrences of vaginal intercourse and women 38.7% (95% CI = 31.0% - 47.0%) of the time (Reece et al., 2010b). Overall, findings of the NSSHB revealed that condom use over the most 10 most recent acts of vaginal intercourse was most common among participants 14 17 years old, followed by those 18 - 24 years old. In addition, among men and women 18 years and older who had participated in anal sex over the last year, condoms were used 20.3% of the time during the past 10 sexual encounters.

Despite the demonstrated efficacy of male latex condoms, few studies have assessed where sexually active individuals typically acquire condoms (Reece, Mark, Schick, Herbenick, & Dodge, 2010). A recent investigation by Reece and colleagues (2010) assessed condom acquisition among 1,832 men living in all 50 U.S. states ages 18 - 75 years old (M = 26.96, SD = 8.69). Results indicated that younger men (29 and younger) were more likely to receive free condoms. In addition, among those who received free condoms, several sources of acquisition were common areas housed within a college or university including a health clinic (20.5%), health fair (13.4%), dorm/student group (8.5%), and classroom (3.6%). Similar results were found among participants who purchased condoms; common acquisition included venues common to collegiate environments including pharmacy (61.0%), grocery store (28.3%), convenience store (10.9%), health clinic (3.7%), and vending machine (3.2%).

Results of the National College Health Risk Behavior Survey, conducted by the CDC, (1997), indicated that 35.1% of students reported having been pregnant or gotten someone pregnant at some point in their life. Recent findings of the Fall 2009 American College Health Association (ACHA): National College Health Assessment II survey revealed that 66.5% of college students have had vaginal, anal, or oral sex with at least one partner over the last 12 months (ACHA, 2009). Among those who had sex with at least one partner during that time, collegiate men reported a M of 2.54 (SD = 4.80) sexual partners and women a M of 1.77 (SD = 2.32) partners. In addition, among those sexually active in the last 30 days, half (51.6%) used a condom or other protective barrier for vaginal sex on most or all occasions, 30.2% for anal sex, and 6.0% for oral sex. Among those who reported using a contraceptive the last time they had vaginal sex, 61.8% used a male condom, 45.0% used a male condom in addition to another form of contraceptive, and .8% used a female condom.

Research related to condom use typically assumes that condom utilization implies correct and consistent use, as well as sufficient condom availability. Empirical studies have identified a high prevalence of condom-related errors among college age young adults (Crosby, Sanders, Yarber, & Graham, 2003; Crosby, Yarber, Sanders, & Graham, 2004; Crosby, Sanders, Yarber, Graham, & Dodge, 2002; Sanders, Graham, Yarber, & Crosby, 2003; Yarber, Graham, Sanders, & Crosby, 2004) as well as a lack of overall condom availability (Crosby et al., 2003; Crosby et al., 2002). These studies suggested that present condom distribution programs at colleges and universities seem inadequate to meet the sexual health care needs of students and that correcting misconceptions about the proper use of male latex condoms should be an educational and public health priority.

One proposed form of primary prevention in education settings are those centered upon increased availability as well as the correct and consistent use of condoms and other safer sex products. Previous studies indicated that adolescent-based condom distribution programs are cost- effective (Bedimo, Pinkerton, Cohen, Gray, & Farley, 2002; Kirby et al., 1999; Schuster, Bell, Berry, & Kanouse, 1998). In addition, assessments of condom availability programs among adolescents revealed that distribution programs increase condom use without increasing sexual activity rates (Blake et al., 2003; Furestenberg, 1997; Guttmacher, 1997).

There is a plethora of research about the sexual health concerns and sexuality-related problems of college students, but little is known about the extent or comprehensiveness of sexuality-related services at college health centers. One study by Koumans et al. (2005) assessed services among higher education institutions included collected data collected in 2001 and published in 2005. The purpose of the study was to identify STI testing services, availability of Papanikolaou (Pap) tests, condom availability, and STI education procedures. Of the 910 colleges selected for participation, the investigators received completed questionnaires from 736 institutions (81% response rate). Of the institutions, 52% distributed condoms to students, including 74% of schools with a health center. When assessing demographic variables associated with condom distribution programs, student population, availability of student housing, institution type (e.g., 2-year or 4-year), and geographic location were all statistically significant. Eighty-five percent of institutions with condom distribution programs had student enrollments of 16,000 or more, 65% offered on-campus housing for students, 58% were public institutions, 64% were 4-year or more institutions, and the most prevalent geographic location with the highest prevalence of condom distribution programs was the Northeast (71%). Results of previous investigations suggested additional comprehensive studies are essential with regard to condom availability and distribution methods among college health centers.

The purpose of the present study was to assess condom and safer sex product availability, condom distribution procedures, and number of condoms distributed/year within college health centers nationwide. Specifically, the foci of the study are six fold and designed to assess the following (a) the prevalence of college health centers nationally that distribute condoms to their student population, (b) the number of condoms distributed to students/year including the M, 95% CI, Med, as well as the number of condoms given to students when adjusted for student population, (c) the relationship between student population size and the number of condoms distributed to students/year, (d) the prevalence of non-condom safer sex products distributed by health centers, (e) the prevalence of condom distribution methods located within health centers as well as those sponsored by centers, and (f) the ability of college and university demographics to predict the presence of a health center-sponsored condom distribution program.

Method

Statistical Power Estimates

A review of relevant literature as well as statistics was used to estimate sample size. McCarthy (2002) measured emergency contraceptive pill availability among college health centers. This study was similar to the present in overarching purpose, study design, and statistical outline. Based on study similarities, the sample size sufficient to detect a significant difference and to...

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